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Get the Most Value From Your Diabetes Medicines
Get the Most Value From Your Diabetes Medicines -- Posted by Gumbo on 04-30-05 07:53
Get the Most Value From Your Diabetes Medicines
Learn how to work with your medicines to get the best care.
By Martin Downs
WebMD Medical News Reviewed By Brunilda Nazario, MD
With some medicines, you can just swallow the pill and let it do its work.
Diabetes medicines require a little effort on your part to get the full
benefits.
Doctors urge people with diabetes to control their blood sugar as tightly as
possible. Good control can greatly reduce the risk of having complications
of the disease. "You take away complications, you take away the sting of
diabetes," James Gavin, MD, chairman of the National Diabetes Education
Program, tells WebMD.
Diabetes complications are not to be taken lightly. People with diabetes are
at least twice as likely to die from a heart attack or stroke as others are.
Diabetes can also lead to kidney failure, blindness, and amputation. Other
complications include pain or numbness in the legs and feet, impotence,
digestive problems, and gum disease.
For those with type 1 diabetes, controlling blood sugar means taking insulin
several times a day. Those with type 2, who make up the vast majority of
people who have the disease, often take one or more diabetes medicines,
sometimes with insulin, too.
Exercise + Diabetes Medicine = Better Control
No matter what you take, a healthy lifestyle should be the cornerstone of
your treatment. Diabetes medicines are designed to work together with a good
diet and regular exercise. "Every medication that has been approved for
diabetes is approved first and foremost as an adjunct to diet and exercise,"
Gavin says.
If you're sedentary and not eating right, "You're working against a
self-imposed gradient of difficulty," he says.
In type 2 diabetes, blood sugar levels are high because the body lacks
sensitivity to insulin, which transports sugars from the bloodstream into
cells. "There is no better way to sensitize the body to insulin than
exercise and weight loss," Paul Jellinger, MD, president of the American
College of Endocrinology, tells WebMD.
Just how much and what kind of exercise you should do depends on your unique
circumstances, but Jellinger says, "It has to be a substantive program --
not just a casual walk."
Typically that means 30 minutes of moderate-intensity exercise on most days
of the week, if not every day.
Some people with type 2 diabetes may be able to control their blood sugar
levels by lifestyle changes alone, to a point where they may be able to stop
taking diabetes medicines. Others may be able to lower the dosage of the
diabetes medicines they take.
Nevertheless, Jellinger says, "There are patients who do all the right
things and still require many medicines."
Healthy living is essential for everyone with diabetes, but the benefits are
most obvious in people who have been diagnosed early in the course of the
disease. "Timing is everything," Gavin says.
Consistently monitoring your blood sugar also helps you get the most from
your diabetes medicines. It is especially important when you are changing
your diabetes medicines or trying to get down to your goal.
"The ultimate goal for everyone is to have a normal blood glucose
concentration," Robert Rizza, MD, president-elect of the American Diabetes
Association, tells WebMD. But in doing so, sometimes it's possible to go too
low and develop hypoglycemia (low blood sugar).
"As you come down to closer to what normal physiology is, maintaining that
balance is more difficult and requires more attention," Rizza says.
"The more frequently you check your sugars, the better it is," Martin
Abrahamson, MD, acting chief medical officer of the Joslin Diabetes Center
at Harvard University, tells WebMD.
By testing often and at various times -- before and after meals, in the
morning and before bed -- you can create a detailed picture of how your
diabetes medicines are working in your body. But not only do you have to
test, you also have to remember to record the results and share them with
your doctor.
"When patients come and see me at the clinic and say, 'I left my logbook at
home,' it's very difficult for me to make adjustments to treatment,"
Abrahamson says.
Controlling Diabetes: Lower Blood Pressure and Cholesterol
"You really need to start with controlling the blood sugar, because that's
the environment in which everything else has to take place," Gavin says.
But that's not all there is to managing diabetes, he says. You must also pay
careful attention to your blood pressure and cholesterol levels, both of
which tend to be high in people with diabetes.
"Controlling the blood pressure in a person with diabetes is probably the
only way that you can protect the kidneys," Gavin says. Keeping your blood
pressure within the normal range also helps prevent stroke, and it and may
slow the progression of vision loss in diabetic eye disease.
Keeping your cholesterol in check not only lowers your risk for heart
disease, it also prevents peripheral vascular disease, commonly called poor
circulation --a condition in which clogged blood vessels cause pain and
numbness in the legs and feet.
Sometimes the right diet, weight loss, and exercise can get your blood
pressure and cholesterol levels under control. But some people may have to
take more medications to do so, like a cholesterol-lowering statin drug or
one or more blood pressure drugs, such as:
a.. ACE inhibitors
b.. ARBs (angiotensin-receptor blockers)
c.. Beta-blockers
d.. Calcium channel blockers
e.. Diuretics (water pills)
Taking a daily low-dose aspirin helps reduce the risk of heart disease and
is also recommended for many people with diabetes, but ask your doctor
first.
Diabetes: A Disease That Progresses
"Taking medication should be expected," Abrahamson says.
It's important to realize that diabetes is a disease that progresses.
Everyone who has it loses some ability to produce insulin over time. Even if
you're able to control your blood sugar now with lifestyle changes alone,
you may need to take diabetes medicine at some point in the future.
What's more, if your diabetes medicine is keeping your blood sugar under
control now, you may still have to take insulin shots in the future.
Abrahamson says that doctors sometimes use insulin as a threat: "If you
don't behave yourself or you're not good, you're going to have to start
insulin therapy." But he says that is the wrong approach. "In reality, for
many patients, insulin therapy is almost a natural consequence of the
disease," he says.
Think about what you have to do to avoid complications, not how you can
avoid taking diabetes medicine. With strict control of blood sugar, you can
slow the progression of the disease and delay complications for a long time.
Published April 2005.
--------------------------------------------------------------------------------
SOURCES: James Gavin, MD, director, National Diabetes Education Program;
president, Morehouse School of Medicine. Paul Jellinger, MD, president,
American College of Endocrinology; professor, University of Miami School of
Medicine. Robert Rizza, MD, president-elect, American Diabetes Association
(ADA); professor of medicine, Mayo Clinic College of Medicine. Martin
Abrahamson, MD, acting chief medical officer, Joslin Diabetes Center. ADA.
Diabetes Care, January 2002, May 2002, January 200
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